Clinical outcome of successful percutaneous coronary intervention for chronic total occlusion: results from the multicenter Korean Chronic Total Occlusion (K-CTO) registry

Abstract

Objectives. To investigate the impact of the success or failure of chronic total occlusion (CTO) interventions on the clinical outcomes in the current drug-eluting stent (DES) era. Background. The impact of the successful CTO intervention on long-term clinical outcomes still remains unclear. Methods. Between 2007 and 2009, a total of 2568 patients with CTO were followed in a multicenter Korean CTO registry. Of these, successful recanalization with DESs occurred in 2045 patients (successful CTO group), whereas failure occurred in 523 patients (failed CTO group). Results. The occurrence of the composite of cardiac death and myocardial infarction (MI) was compared between the successful CTO and failed CTO groups. During follow-up (median duration, 729 days), the occurrence of cardiac death or MI was significantly lower in the successful CTO group than in the failed CTO group (1.7% vs 3.3%; hazard ratio, 0.50; 95% confidence interval, 0.28-0.91; P=.02) and the cumulative occurrence in the successful CTO group was also significantly lower than in the failed CTO group (1.7% vs 3.0%; P=.03) by the Kaplan-Meier method. The successful CTO group had a significantly lower need for bypass surgery than the failed CTO group (0.2% vs 2.5%; P<.001). In multivariate analysis, procedural success of CTO (odds ratio, 0.51; 95% CI, 0.29-0.92) was significantly predictive of the occurrence of cardiac death or MI, together with age and left ventricular ejection fraction <40%. Conclusion. This registry study demonstrated that successful CTO intervention with DESs compared to failed CTO intervention was associated with lower event rates during follow-up.